Trigger Finger

• Most common in the sixth decade, women, people with diabetes or rheumatoid arthritis and in the dominant hand
• Caused by inflammation and contriction of the flexor tendon sheath through which the flexor tendons run from palm to the finger
  • Causes irritation of the tendon, and occasionally formation of a nodule, which impinges on the tendon movement, causing pain and restriction of finger movement
  • In the finger, there are 5 annular ‘pulleys’ which hold the tendon close to the bone.  The A1 pulley (at the metacarpal head) is the first and subject to most force.
    • It is here where triggering tends to occur
• Presentation
  • Intermittent painful locking of the finger in flexion (ask how easy this is to overcome, as this can indicate severity)
  • Examination may reveal palmar or digital nodule
    • look also for any evidence of rheumatoid, carpal tunnel (often concurrent)
• Management
  • Local (A1) steroid injection (57% resolve after 1 and 86% with 2 injections)
  • Surgery (usually if 2 steroid injections have failed)
  • Splinting is also an option (can be effective but often causes stiffness)

Advertisement